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Satisfactory Outcomes (satisfactory + outcome)
Selected AbstractsLong-term exclusive zinc monotherapy in symptomatic Wilson disease: Experience in 17 patients,HEPATOLOGY, Issue 5 2009Francisca H. H. Linn Exclusive monotherapy with zinc in symptomatic Wilson disease is controversial. Seventeen symptomatic patients with Wilson disease were treated with zinc only. The mean age at diagnosis and start of treatment was 18 years (range 13,26) with approximately half presenting as adolescents. Presentation was exclusively hepatic, exclusively neurologic, and combined in seven, five, and five patients, respectively. The median follow-up was 14 years (range 2,30). At baseline, two of the 12 patients with hepatic disease exhibited decompensated cirrhosis, five exhibited compensated cirrhosis, and five had less severe disease. Both patients with decompensated cirrhosis improved to a compensated state after initiation of therapy. Two of the five patients with initial compensated cirrhosis progressed to decompensated state, and three remain stable. Three of the five patients with moderate or mild liver disease remain stable and two improved. Apart from decreasing bilirubin levels, no significant changes occurred in the liver biochemistry or function during long-term follow-up. Nine of 10 neurologic patients improved markedly and one deteriorated. Two patients with exclusively neurologic presentation developed liver disease during zinc treatment. Two patients with exclusively hepatic presentation developed mild neurologic symptoms. According to 24-hour urinary copper excretions (213 ± 38 versus 91 ± 23 ,g: P = 0.01) and serum non,ceruloplasmin-bound copper concentrations (11 ± 2 versus 7 ± 1 ,g/dL: P = 0.1) at the end of follow-up, the efficacy of decoppering was less in the exclusively hepatic than in the neurologic group. The prescribed zinc dose and 24-hour urinary zinc excretions tended to be less in the exclusively hepatic group. Conclusion: The outcome of exclusive zinc therapy is generally good in cases of neurologic disease. A less satisfactory outcome in hepatic disease may relate to less efficient decoppering. (HEPATOLOGY 2009.) [source] Determining elastic constants of transversely isotropic rocks using Brazilian test and iterative procedureINTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 3 2008Yen-Chin Chou Abstract The elastic constants of rocks are the basic parameters for rock mechanics, and play a very important role in engineering design. There are many laboratory methods to determine the elastic constants of transversely isotropic rocks, and the Brazilian test is a popular method. This paper presented a method combination of the Brazilian test, back calculation, and iterative procedure to evaluate the five independent elastic constants of transversely isotropic rocks in laboratory. The strain data at the centre of discs were obtained using Brazilian test. The stresses at the centre of discs were computed using numerical programs. By using back calculation, the temporary elastic constants were computed after the stresses and stains were substituted into elastic mechanics equations. After iterative procedure, the convergent values of the elastic constants can be obtained. One numerical example and three experimental cases were proposed to show the applicability of this method. The convergent values of the five independent elastic constants can be obtained in no more than 10 iterative cycles. The results coming from numerical analysis method exhibited satisfactory outcome in accordance with those of generalized reduced gradient method. The merits of this method include convenient specimen preparation of the Brazilian test, simple iterative procedure, and readily available commercially numerical programs, so that this method can be easily popularized in research and engineering analysis. Copyright © 2007 John Wiley & Sons, Ltd. [source] Biliary reconstruction for infantile living donor liver transplantation: Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy?LIVER TRANSPLANTATION, Issue 12 2008Yasumasa Shirouzu Hepaticojejunostomy is a standard biliary reconstruction method for infantile living donor liver transplantation (LDLT), but choledochocholedochostomy for infants is not generally accepted yet. Ten pediatric recipients weighing no more than 10 kg underwent duct-to-duct choledochocholedochostomy (DD) for biliary reconstruction for LDLT. Patients were followed up for a median period of 26.8 months (range: 4.0,79.0 months). The incidence of posttransplant biliary complications for DD was compared with that for Roux-en-Y hepaticojejunostomy (RY). No DD patients and 1 RY patient (5%) developed biliary leakage (P > 0.05), and biliary stricture occurred in 1 DD patient (10%) and none of the RY patients (P > 0.05); none of the DD patients and 5 RY patients (25%) suffered from uncomplicated cholangitis after LDLT (P > 0.05), and 1 DD patient (10%) and 2 RY patients (10%) died of causes unrelated to biliary complications. In conclusion, both hepaticojejunostomy and choledochocholedochostomy resulted in satisfactory outcome in terms of biliary complications, including leakage and stricture, for recipients weighing no more than 10 kg. Liver Transpl 14:1761,1765, 2008. © 2008 AASLD. [source] Chronic oral ulcer associated with CandidaMYCOSES, Issue 2 2010Haruhiko Terai Summary In the patients with HIV infection, fungal diseases may cause ulceration in the oral cavity; however, there have been few studies on oral ulcerative lesions associated with Candida in the patients without HIV infection. Our study included six patients with chronic oral ulcer of unknown origin; these patients were referred to our department after topical steroid therapy to the lesion was ineffective. Cases of traumatic ulcers and recurrent aphthous stomatitis were excluded. Blood, histopathological, culture and direct cytological examinations were performed. All the patients were treated with topical miconazole gel. Histopathological examination revealed no specific findings besides inflammatory cellular infiltration with positive haematoxylin,eosin staining in all cases. Candida spp. were isolated in four cases by culture test, and fungal pseudohyphae were revealed in four cases by direct examination. The anti-fungal treatment produced a satisfactory outcome with complete remission in five cases and remarkable response in one case. These results suggested that Candida should be considered as playing an important role in a certain oral ulcer. [source] Photodynamic therapy for the treatment of a giant superficial basal cell carcinomaPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 1 2009Donato Calista Summary A 74-year-old man was referred to our department for the treatment of a 15 × 15 cm superficial basal cell carcinoma (BCC) on his lumbar region. As surgical excision was considered too destructive, photodynamic therapy (PDT) was proposed. Methyl 5-aminolevulinate (MAL) cream was applied under occlusion for 3 h before illumination with a light-emitting diode lamp with an emission peak of 632 nm, a fluence rate of 83.3 mW/cm, and a light dose of 37 J/cm. A second MAL-PDT session was repeated 1 week later. The neoplastic area healed in 30 days. No recurrence has occurred after a 40-month follow-up period, but clinical observation continues. Although surgery still remains the treatment of choice for giant BCC, for which the local invasiveness and metastatic potential are well known, we offered our patient the option of PDT because we believed that classical surgery could hardly provide the same satisfactory outcome. As far as we know, this is the first case of giant BCC treated with PDT. [source] Strategy for the surgical management of patients with idiopathic megarectum and megacolon,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2001C. B. Ó Súilleabháin Background: Several surgical procedures have been used to treat idiopathic megabowel. A structured approach to the surgical management of megarectum/colon is reported. Methods: Twenty-eight consecutive patients with megabowel referred for surgery were reviewed. All patients had conservative treatment for 6 months. Those failing to improve underwent full-thickness biopsy of the anorectal junction, anorectal physiology studies, colonic transit studies and evacuation proctography. Surgery involved excision of the abnormal large bowel and formation of an anastomosis (coloanal or ileoanal) using ,normal' bowel identified either by a defunctioning stoma or colonic motility studies. Results: Eight patients responded to conservative management. Two patients were lost to follow-up and one died from unrelated causes. Two of the 17 patients who underwent full-thickness biopsy were cured by the procedure. Anorectal physiology, colonic transit and evacuation studies did not aid selection of the surgical procedure performed in 15 patients: proctectomy and coloanal anastomosis (six), restorative proctocolectomy (three), panproctocolectomy (one) and defunctioning stoma (five). At a median follow-up of 3·6 years, 13 of 15 evaluable patients had a satisfactory outcome. Conclusion: Approximately 40 per cent of patients with megabowel referred for surgery responded to conservative treatment. The remaining patients may be treated successfully by surgery. The use of either a ,diagnostic' defunctioning stoma or colonic motility studies may aid in the choice of surgical procedure. © 2001 British Journal of Surgery Society Ltd [source] Managing the environmental adaptation process in supplier,customer relationshipsBUSINESS STRATEGY AND THE ENVIRONMENT, Issue 4 2001Louise Canning This paper details the results and managerial implications from four case studies, which examine how the environmental adaptation process (EAP) is managed within business-to-business relationships. The research uses models of supplier,customer interaction and inter-organization cooperation in order to explore inter-firm relationships and the process of adaptation. The research findings show that either party might pursue adaptations and also establishes features of the process itself as well as identifying factors that can facilitate or hinder the introduction of environmental changes. Arriving at a satisfactory outcome to the adaptation process can be determined by individual company and relationship characteristics, as well as the behaviour and experience of those managers involved in the process. Guidelines for the management of the process of environmental adaptation are proposed. Copyright © 2001 John Wiley & Sons, Ltd and ERP Environment [source] Management of diverticular fistulae to the female genital tractCOLORECTAL DISEASE, Issue 5 2007F. Hjern Abstract Objective, Fistulae to the female genital tract are an infrequent but severe complication of diverticular disease. The purpose of this study was to evaluate treatment and outcome in patients with diverticular colo-genital fistulae. Method, Sixty women treated for diverticular fistulae (DF) to the female genital tract during 1992,2004 were identified. Clinic and operative charts were reviewed. Mean age was 70 years and mean follow-up time after surgery was 1 year. Results, Most common presenting symptoms were vaginal discharge of faeces or gas (95% of patients) and abdominal pain (43%). About 75% of patients had undergone a hysterectomy. Forty-six patients underwent at least one radiological contrast study and the fistula was demonstrated in 35 (76%) patients. Fifty-seven patients had surgery, and findings included colo-vaginal fistulae (n = 47), colo-uterine fistulae (n = 2) and multiple fistulae involving vagina and other organs (n = 8). A sigmoid resection and primary anastomosis was performed in 51 and a Hartmann procedure with colostomy in six patients. Sixteen (28%) patients experienced morbidity after surgery, including anastomotic dehiscence (n = 4) and ureteric injury (n = 3). There was no mortality. Conclusion, Diverticular fistulae to the female genital tract usually occur in elderly patients with a prior hysterectomy. Radiological contrast studies demonstrate the fistulous tract in most cases. Sigmoid resection and primary anastomosis results in a satisfactory outcome in the majority of patients. [source] Subcutaneous Pedicle Limberg Flap for Facial ReconstructionDERMATOLOGIC SURGERY, Issue 8 2005Li Jun-Hui MD Background. A residual dog-ear arising from the traditional Limberg flap transposition sometimes influences the cosmetic outcomes, and the Limberg flap with a subcutaneous pedicle is an innovation applicable to a variety of facial defects and free from the dog-ear. Objective. To investigate the outcome of the subcutaneous pedicle Limberg flap for the reconstruction of medium-sized facial skin defects. Materials and Methods. From August 2002 to June 2004, the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients (19 flaps), and the size of the lesions ranged from 2.0 × 1.9 cm to 5.0 × 4.5 cm. Results. All flaps survived with primary healing postoperatively. The patients were followed up from 1 to 22 months, and functionally and cosmetically satisfactory outcomes were achieved. Conclusions. This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face. [source] The National Treatment Outcome Research Study (NTORS): 4,5 year follow-up resultsADDICTION, Issue 3 2003Michael Gossop ABSTRACT Aims ,The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings. Design, setting and participants,The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4,5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities. Measurements, Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime. Findings, Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non-prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4,5 years were not significantly different from intake. Conclusions, Substantial reductions across a range of problem behaviours were found 4,5 years after patients were admitted to national treatment programmes delivered under day-to-day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large-scale, multi-site studies. [source] Pulmonary Embolectomy: Recommendation for Early Surgical InterventionJOURNAL OF CARDIAC SURGERY, Issue 3 2010Enisa M. Carvalho M.D. Despite all efforts at improving outcomes, there is no consensus on the management of acute severe PE. Methods: From May 2000 to June 2009, 16 consecutive patients underwent surgical pulmonary embolectomy at our institution. Mean age was 45 ± 17 years (range, 14 to 76) with nine (56%) males and seven (43%) females. Preoperatively, all cases were classified as massive PE; seven (43%) patients were in hemodynamic collapse and emergently underwent operation while receiving cardiopulmonary resuscitation. Results: There were nine (56%) urgent/emergent and seven (44%) salvage patients undergoing surgical pulmonary embolectomy. Of nine nonsalvage patients, seven (77%) patients presented with moderate to severe right ventricular (RV) dilation/dysfunction. Mean cardiopulmonary bypass time was 43 ± 41 minutes (range, 9 to 161). Mean follow-up duration was 48 ± 38 months (range: 0.3 to 109), with seven in-hospital deaths (43%): mortality was 11% (1/9) in emergent operations and 85% (6/7) in salvage operations. Conclusions: Surgical pulmonary embolectomy should be considered early in the management of hemodynamically stable patients with PE who show evidence of RV dilation and/or failure, as it is associated with satisfactory outcomes. Conversely, pulmonary embolectomy has dismal results under salvage conditions. Revision of current guidelines for the surgical management of this condition may be warranted. (J Card Surg 2010;25:261-266) [source] The science and art of hyaluronic acid dermal filler use in esthetic applicationsJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2009Michael Gold MD Summary Background, The number of dermal fillers has expanded dramatically; clinicians can benefit from practical information on their optimal use. Aims, To review key determinants of dermal filler performance, to discuss technical considerations, and to illustrate these factors based on the author's clinical experience. Methods, Current literature pertaining to the physicochemical properties of hyaluronic acid (HA) dermal fillers and implications for clinical use was reviewed. The author provides clinical guidelines for optimizing outcomes, illustrated with three case examples. Results, Hyaluronic acids are nonimmunogenic, versatile, reversible, and have excellent benefit,risk profiles, making them near-ideal filling agents. They differ in their manufacturing processes, viscosity, hardness, cohesivity, ease of injection, and ideal uses. Patient counseling and education with individualized selection of the appropriate agent is critical to provide satisfactory outcomes. Conclusions, Clinicians must be technically proficient, balance esthetic need with facial anatomy, and consider HA properties to provide optimal outcomes. [source] Tension-free vaginal tape-obturator procedure for treatment of severe urodynamic stress incontinence: Subjective and objective outcomes during 2 years of follow-upJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2009Tsung-Hsien Su Abstract Aim:, To report our experience of the tension-free vaginal tape-obturator (TVT-O) procedure for the treatment of severe female urodymanic stress incontinence (USI) during 2 years of follow-up. Methods:, Between January 2005 and June 2007, 67 women with severe USI who underwent the TVT-O procedure were enrolled in the study. Pelvic examination, pad test, urodynamic study, and quality of life (QoL) assessment were performed pre- and post-operatively. Regular follow-up was arranged for analysis. Results:, The median duration of follow-up was 24 months. The objective cure rate was 76.2%. The postoperative pad test revealed significant reduction of leakage. The subjective cure rate was 83.5%, and improvement occurred in 14.9%. The postoperative QoL showed significant improvement. One (1.5%) extrusion of tape occurred and three cases of de novo detrusor overactivity were detected. Three patients (4.4%) had immediate postoperative urine retention. No major complications occurred. Conclusion:, Our results show that the TVT-O procedure is an effective and safe surgical procedure for severe female USI with satisfactory outcomes, significant improvement in quality of life, and few complications during 2 years of follow-up. [source] Nondigital tissue replantation and microsurgical spare part utilization in mutilated hands: Case reports and reviewMICROSURGERY, Issue 2 2007Serdar Nasir M.D. Five cases with microsurgical utilization of spare parts from unreplantable amputated segments are presented. Besides, nondigital composite tissue replantations are firstly reported in hand. They all resulted in satisfactory outcomes compared to alternative treatments without any donor site morbidity. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source] The feasibility and reliability of using circular electrode for sphincter of Oddi electromyography in anaesthetised rabbitsNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2009F. Chen Abstract, Sphincter of Oddi manometry (SOM) is the gold standard for assessing sphincter of Oddi dysfunction (SOD), but is considered a diagnostic sensitivity of 30,80% and associated with significant complications of pancreatitis. Electromyography (EMG) of sphincter of Oddi (SO) using a circular electrode (CE) may be useful in improving diagnostic accuracy and reducing complications. To evaluate the feasibility and reliability of the CE, we record myoelectric activity of SO in rabbits using the CE to compare with the traditional needle electrode (NE). The CE was prepared using a double-channel biogel catheter with two silver rings at the head of the catheter. The CE was then inserted into the lumen of the SO through the duodenal papilla, and myoelectric activity was recorded in the SO in 30 rabbits. An EMG recorded using an NE was performed at the same time, when the SO was in basal state, after injection of cholecystokinin and N-butylscopolamine bromide. Electromyographs recorded by the two methods were then evaluated. Satisfactory SO EMGs were acquired using the CE without any injury. Simultaneous recording revealed a very similar traces and one-to-one correspondence of SO spike bursts (SOSB). Linear regression analysis showed a significant direct correlation between the two methods for SOSB duration and amplitude. The results suggested that CE was comparable with NE in terms of recording efficacy. The CE also has advantages of easy fixation, accurate localisation, broad applicability and ease of achieving satisfactory outcomes without trauma, compared with the NE. [source] Traces of the secondary Geography curriculumNEW ZEALAND GEOGRAPHER, Issue 2 2005Lex Chalmers Abstract:, Expressions of dissatisfaction about the post-compulsory Geography curriculum in the early 1970s were unusually concerted, leading to the creation of a National Geography Curriculum Committee. This essay reviews this history and the resulting Syllabus for Schools: Geography Forms 5,7 as a prelude to a discussion of contemporary curriculum development. The essay argues that curriculum development from 1975 and the ,education reforms' of the late 1980s failed to produce conditions in which satisfactory outcomes for a Geography curriculum can be assured in 2005, and that a new and concerted period of participation in curriculum discussion is required. Some goals for this process are outlined in the final section of the paper. [source] Clarity of Responsibility and CorruptionAMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 1 2007Margit Tavits This article demonstrates that political institutions influence the level of corruption via clarity of responsibility. The key hypothesis is that when political institutions provide high clarity of responsibility, politicians face incentives to pursue good policies and reduce corruption. These incentives are induced by the electorates' rejection of incumbents who do not provide satisfactory outcomes. However, if lines of responsibility are not clear, the ability of voters to evaluate and punish politicians,as well as to create incentives for performance,declines. The findings confirm that countries with institutions that allow for greater clarity of responsibility have lower levels of corruption. [source] Long-term outcomes of revisional surgery following laparoscopic fundoplicationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2009P. J. Lamb Background: A small proportion of patients who have laparoscopic antireflux procedures require revisional surgery. This study investigated long-term clinical outcomes. Methods: Patients requiring late revisional surgery following laparoscopic fundoplication for gastro-oesophageal reflux were identified from a prospective database. Long-term outcomes were determined using a questionnaire evaluating symptom scores for heartburn, dysphagia and satisfaction. Results: The database search found 109 patients, including 98 (5·6 per cent) of 1751 patients who had primary surgery in the authors' unit. Indications for surgical revision were dysphagia (52 patients), recurrent reflux (36), mechanical symptoms related to paraoesophageal herniation (16) and atypical symptoms (five). The median time to revision was 26 months. Outcome data were available for 104 patients (median follow-up 66 months) and satisfaction data for 102, 88 of whom were highly satisfied (62·7 per cent) or satisfied (23·5 per cent) with the outcome. Patients who had revision for dysphagia had a higher incidence of poorly controlled heartburn (20 versus 2 per cent; P = 0·004), troublesome dysphagia (16 versus 6 per cent; P = 0·118) and a lower satisfaction score (P = 0·023) than those with recurrent reflux or paraoesophageal herniation. Conclusion: Revisional surgery following laparoscopic fundoplication can produce good long-term results, but revision for dysphagia has less satisfactory outcomes. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010FSCAI, Osami Kawarada MD Abstract Objective: The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. Background: There is no consensus on the best approach for threatened limbs in patients with graft occlusion. Methods: The subjects were nine consecutive patients with limb-threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. Results: The mean age of the bypass grafts was 6.7 ± 7.3 (range: 1,24) months and the mean number of previous lower limb bypass surgeries was 1.4 ± 0.5 (range: 1,2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal-tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle-brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 ± 1.1,0.9 ± 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow-up time of 25 ± 20 months (range: 9,60). Conclusions: In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion. © 2010 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||